Millions of Americans undergo urinary catheterization annually. Catheter-related urinary tract infection (DTI) is the most common infection seen in long-term care facilities and a common source of septicemia, which results in death for 2 of every 10 patients. Yet there are no prospective studies in a nationally representative sample of Americans that enumerate the risk of UTI and septicemia in residents of long-term care facilities. Nor are there population-based studies of the determinants and consequences of such risk. This study was designed to address these issues. The first aim of this study is to describe use of urinary collection devices in a cohort of residents in long-term care facilities and determine the antecedent factors and effects of such use. The Long Term Care Minimum Data Set for California, Texas, New York, Florida, and Michigan, years 2002-2003, will be utilized. The selected states represent 34.9% of the elderly population in the United States. The second aim is to determine the risks, both incident and recurrent, of UTI and septicemia by bladder management strategy in residents of long-term care facilities. Hospitalization rates due to UTI and septicemia will also be ascertained. A population-based cohort study will be conducted, using linked databases containing information from the Long Term Care Minimum Data Set and Medicare data from acute care hospitals in California, Texas, New York, Florida, and Michigan, years 2002-2003. The Minimum Data Set has information on the physical functioning, health conditions, medical diagnoses, activities of daily living, cognition, sensory and communication patterns, behavior, diet, activity patterns, psychosocial wellbeing, and background of each patient, so that individuals at greater risk of infection or hospitalization can be identified. This investigation would be the first population-based study to characterize those individuals at higher risk of UTI and septicemia in long-term care facilities in the United States. This will provide valuable baseline information for surveillance purposes, preventive efforts, and health care planning. Since approximately 40% of elderly Americans will enter a nursing home at some point, identification of those at risk of infection could have considerable health, quality of life, and economic consequences.